The Respiratory System

State the general role of the lungs in oxygen and carbon

dioxide exchange
Supply body with O2 and dispose of CO2

Define the following terms:

PaO2: partial pressure oxygen in arteries
PAO2: partial pressure oxygen in alveoli
PaCO2: partial pressure carbon dioxide in arteries
PACO2: partial pressure carbon dioxide in alveoli
Respiratory pressures are always described relative to atmospheric
pressure
Gases travel from an area of higher pressure to an area of lower pressure

Define the internal respiration and external respiration

Internal respiration: O2 diffuses from blood to tissue cells, and CO2
diffuses from tissue to blood
External respiration: O2 diffuses from lungs to blood, and CO2 diffused
from blood to lungs

Ventilation
Define the terms intra-pleural pressure, lung compliance and
surfactant
Intrapleural pressure: pressure in the pleural cavity, is always negative
compared to pressure within the alveoli. The difference keeps the lungs
from collapsing
Lung compliance: a measure of the lung's ability to stretch and expand,
specifically a measure of the change in lung volume that occurs with a
given change in transpulmonary pressure (difference between pressure in
the alveoli (Ppul) and intrapleural pressure (Pip))
The higher the lung compliance, the easier it is for the lungs to expand at
any given transpulmonary pressure, meaning efficient ventilation
△VL
C L=
△ ( P pul −Pip )
Surfactant: a complex of lipids and
proteins produced by the type II
alveolar cells that decreases the
cohesiveness of water molecules
(reducing the attraction of water for
water). Less energy is needed to
overcome these forces to expand the
lungs and discourage alveolar
collapse. Breaths that are deep stimulate type II alveolar cells to secrete
more surfactant

State the relationship between volume change and pressure

change and between intra-pulonary pressure and air flow
According to Boyle’s law, volume is directly proportional to pressure
Increasing the volume of the thoracic cavity decreases Ppul, meaning
atmospheric air rushes into the lungs down its pressure gradient
Describe the mechanics of pulmonary ventilation

Role of lung elasticity in normal expiration

The lungs natural tendency to recoil due to their elasticity, lungs always
assume the smallest possible size

Importance of alveolar and pleural pressures in ventilation

Opposing forces exist in the thorax: two forces act to pull the lungs
(visceral pleura) away from the thorax wall (parietal pleura) and cause the
lungs to collapse (opposed by the natural elasticity of the chest wall
Role of respiratory muscles in ventilation
- Inspiration
o Contraction of the diaphragm increasing the superior-inferior
dimension of the thoracic cavity (most important)
o External intercostal muscles contract lifting the rib cage and
pull the sternum superiorly, expanding the thoracic cavity
laterally and in the anteroposterior plane
o Expands the lung volume by 500ml
o Lungs expand and the Ppul decreases by 1mmHg relative to
atmospheric pressure
o Pip decreases to -6mmHg relative to Patm
o Inspiration ends when Ppul = Patm
o During forced inspiration accessory muscles assist with
increasing thoracic volume
 Scalenes, sternocleidomastoid, pectoralis minor raise
the ribs more
 Erector spinae muscles tighten to extend the back
- Expiration
o Rib cage descends and lungs recoil due to elasticity
o Thoracic and intrapulmonary volume decreases
o Compresses the alveoli and Ppul increases to 1mmHg above
Patm
o During forced expiration, abdominal wall muscles contract
(oblique and transversus)
 Increase intra-abdominal pressure forcing the abdominal
organs against the diaphragm and also depress the rib
cage
 Internal intercostal muscles assist to depress the rib
cage and decrease thoracic volume
Explain the impact of surfactant on lung compliance
Surfactant increases lung compliance since it decreases the attraction
forces within the alveoli

Define the terms minute ventilation and alveolar ventilation

Minute ventilation: total amount of gas that flows into or out of the
respiratory tract in 1 minute; provides rough estimate for assessing
respiratory efficiency
- During normal inspiration: 6L/min (500ml per breath x 12 breaths)
- During exercise: may reach 200L/min
Alveolar ventilation: measure of respiratory efficiency by taking into
account the air within the dead space, and only accounts for volume of air
within the alveoli
AV = tidal volume – dead space
Compare the composition of alveolar air and atmospheric air
and explain the differences noted
Gas exchanges occurring in the lungs (O2 decreases, CO2 increases)
- Humidification of air by conducting passages (H2O increases)
- The mixing of alveolar gas and newly inspired air

Physical factors influencing pulmonary ventilation

 Airway resistance: caused by friction in the airway passages

 Alveolar surface tension: fluid acts to reduce alveolar size and

colapse the alveoli (surfactant reduces this tendency)
 Lung compliance: depends on elasticity of lung tissue and flexibility
of the bony thorax (when compliance impaired inspiration becomes
more difficult)

Lung volumes and capacities

Define the follownig lung volumes
Tidal volume: the volume of air that moves into and then out of the
lungs with each breath (500ml)
Inspiratory reserve volume: the amount of air that can be inspired
forcibly beyond tidal volume (2100 to 3200ml)
Expiratory reserve volume: amount of air that can be expelled from the
lungs after normal tidal volume expiration (1000 to 1200ml)
Residual volume: about 1200ml of air remaining after expiration which
helps keep the alveoli open and prevent lung collapse

Define the following lung capacities

Vital capacity: the total amount of exchangeable air
Total lung capacity: is the sum of all lung volumes (approximately 6L)
Dead space: air within conducting respiratory passages and never
contributes to alveoli gaseous exchange, approximately 150ml
Alveolar diffusion
Define
Alveolar diffusion: gas exchange of O2 and CO2 within the alveoli of the
lungs
Intrapulmonary pressure: pressure in the alveoli (it rises and falls with the
phases of breathin but it always equalisez with the atmospheric pressure
eventually

Indicate how the partial pressures of gasses differ in the

alveoli as compared to the blood
In blood In blood
leaving lungs tissues and
In and entering entering In
In Atm
alveoli tissue lungs tissue
(oxygenated) (deoxygenat
ed)
decreases
PO2 160 104 100 mmHg 40 mmHg <40
mmHg mmHg mmHg
PCO2 0.3 40 40 mmHg 45 mmHg >45
mmHg mmHg mmHg

increases

List the factors which influence the rate of gas diffusion

through the respiratory membrane
- Thickness and surface area of respiratory membrane
o Membrane is very thin allowing efficient gas exchange
o Structure of the alveoli mean that surface area is massive
- Partial pressure gradients and gas solubilities
o Partial pressures drive the diffusion of gases across the
respiratory membrane
o At the respiratory membrane, in alveoli PO2 is at 100mmHg
and in the deoxygenated blood, PO2 is only 40mmHg, creating
a steep gradient
o Equilibrium occurs when PO2 is both at 104mmHg, occurs after
0.25s
 o Even though the PCO2 gradient is much less steep, equal
amounts of these gases diffuse because CO2 is 20 times more
soluble in plasma and alveolar fluid than O2
- Ventilation-perfusion coupling that matches alveolar
ventilation with pulmonary blood perfusion
o Ventilation: amount of gas reaching alveoli
o Perfusion: the blood flow in the pulmonary capillaries
o For optimal gas exchange, ventilation must match perfusion
o These factors are controlled by local autoregulatory
mechanisms:
 PO2 controls perfusion by changing arteriolar diameter
 PCO2 controls ventilation by changing bronchiolar
diameter
o Alveolar ventilation perfusion (VA:Q) ratio
The transport of O2 and CO2 in blood
List the ways in which oxygen and carbon dioxide are
transported in the blood, and in which proportions & State
the chemical components of haemoglobin that binds oxygen
and carbon dioxide respectively and give the name of the
resulting compounds
Oxygen is transported by
- Haemoglobin (98.5%)
o Oxyhaemoglobin (HbO2) – iron molecule in the heme group
binds O2
o Deoxyhaemoglobin (HHb)
- Dissolved in plasma (only 1.5%)
Carbon dioxide is transported as
- Dissolved in plasma (7-10%)
- Bound to haemoglobin (20%)
o Carbaminohaemoglobin
o CO2 binds directly to amino acids of the haemoglobin, not the
heme group
o Deoxyhaemoglobin combines more readily with CO2 than
Oxyhaemoglobin (Haldane effect)
- As bicarbonate ions in plasma (70%)
o Most CO2 entering the plasma quickly enter the RBCs
o RBCs contain carbonic anhydrase needed to convert CO2 
HCO3-
o H+ ions released in this reaction bind to Hb, triggering the
Bohr effect
 CO2 loading enhances O2 release
 When tissues need O2 (and have high levels of CO2,
meaning increase in PCO2), it causes the Hb to dissociate
O2
 Increased PCO2 or H- concentration (decreased pH)
causes the dissociation curve to shift to the right

Draw the normal oxygen-haemoglobin dissociation curve

(with named X and Y axes)
Normal oxygen-haemoglobin dissociation curve: S-shaped
- Y axis shows the saturation of Hb. At 100%, the Hb molecule has 4
bound oxygen atoms
- X axis shows the PO2 within the lungs/tissues etc
- Decrease in pH and an increase in PCO2 changes Hb conformation,
reducing its ability to bind O2, thereby unloading O2 into the plasma
for tissues
The ventilation-perfusion ration
Define what is meant by the alveolar ventilation: perfusion
ratio in the lungs
Ventilation-perfusion coupling that matches alveolar ventilation with
pulmonary blood perfusion
- Ventilation: amount of gas reaching alveoli
- Perfusion: the blood flow in the pulmonary capillaries
- For optimal gas exchange, ventilation must match perfusion
Explain how autoregulation in the lungs attempts to
maximise that VA:Q ratio by modifying arteriolar and
bronchiolar diameters
These factors are controlled by local autoregulatory mechanisms:
o PO2 controls perfusion by changing arteriolar diameter
o PCO2 controls ventilation by changing bronchiolar diameter
- Alveolar ventilation perfusion (VA:Q) ratio: a measurement
used to assess the efficiency and adequacy of the matching of two
variables
Explain why the apex of the lungs tends to have a higher
VA:Q ratio than the bases, in an erect person
- Gravity causes regional variations in blood and air flow in the lungs
- Some alveolar ducts may be plugged with mucus creating
unventilated areas
- Blood shunted from bronchial vein

Regulation of respiration
State the areas of the body that contai chemoreceptors that
control respiration
Chemoreceptors are receptors that monitor changes in CO2, O2 and H+
levels in the blood
Identify the location of the respiratory control centres in the
CNS, state which chemical changes they primarily respond to
and describe the nature of this response
- Medulla oblongata
o Impulses travel along phrenic and intercostal nerves to excite
the diaphragm and external intercostal muscles during
inspiration
o During expiration, no impulses are fired and the muscles relax
automatically
 o Cyclic on/off activity repeats 12-15 times per minute
- Pons: Influence and modify activity of medullary neurons
- Hypothalamus and limbic system: Strong emotions and pain
stimulate deep and faster breathing
- Cerebral motor cortex: Voluntary control over breathing

Identify the location of the peripheral chemoreceptors in the

body, state which chemical changes they respond to and
describe the nature of this response
- Peripheral chemoreceptors are found in aortic arch and carotid
arteries influenced by
o PO2
 Arterial PO2 must drop substantially (to 60mmHg) to
become a major stimulus for increased ventilation
 Hb serve as a huge O2 reservoir
o Decreased pH
 From CO2 retention, accumulation of lactic acid, DKA
 Increases ventilation rate and depth to try eliminate
CO2 (and HCO3-) from the blood
State the most potent chemical influencing respiration
- Central chemoreceptors are found in throughout the brain stem
influenced by
o PCO2 (most potent)
 CO2 accumulates in the brain and is converted to HCO3-
 The H+ given off excites central chemoreceptors
 Depth and rate of breathing increase
- Peripheral chemoreceptors

List the neural influences on the brainstem respiratory

centres

Cortical controls
Although the brain stem respiratory centres normally regulate breathing
involuntarily we can also exert conscious control over the rate and depth
of our breathing. During voluntary control the cerebral motor cortex sends
signals to the motor neurons that stimulate the respiratory muscles, by
passing the medullary centres. Our voluntary control is however limited,
because the brainstem respiratory centres automatically reinitiate
breathing when the blood concentration of CO2 reaches critical levels.